Browsing by Subject "follow-up studies"

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  • Pylväläinen, Juho; Talala, Kirsi; Murtola, Teemu; Taari, Kimmo; Raitanen, Jani; Tammela, Teuvo L.; Auvinen, Anssi (2019)
    Purpose: To evaluate the performance of Charlson Comorbidity Index (CCI) calculated using hospitalization and medication reimbursement databases in predicting mortality. Patients and methods: Information on hospitalizations was obtained from the national Care Register for Health Care (HILMO) and on medication reimbursements and entitlements for special reimbursements for medications from the Social Insurance Institution for 77,440 men aged 56-71 years at baseline. The subjects were followed up for mortality via Statistics Finland with 20,562 deaths during a 13-year follow-up. Results: Compared to a CCI score of 0, the age-adjusted hazard ratio for all-cause mortality associated with HILMO-based CCI scores of 1, 2 and 3 or more were 2.39 (95% CI 2.29-2.49), 2.96 (95% CI 2.81-3.13) and 6.42 (95% CI 5.95-6.93) at 13 years. The C-statistic was 0.72 at 1, 0.68 at 5 and 0.66 at 13 years, with only minor improvement over age alone (0.10, 0.06 and 0.04 accordingly). Addition of medication data did not improve predictive abilities and medication-based CCI performed poorly on its own. Conclusion: The hospitalization-based CCI, as well as that based on both databases, predicts relative mortality adequately, but its discriminative ability diminishes over time. Conditions related to hospitalizations affect survival more than medications.
  • Relander, Kristiina; Hietanen, Marja; Nuotio, Krista; Ijäs, Petra; Tikkala, Irene; Saimanen, Eija; Lindsberg, Perttu J.; Soinne, Lauri (2021)
    Background: Carotid endarterectomy (CEA) has been associated with both postoperative cognitive dysfunction (POCD) and improvement (POCI). However, the prognostic significance of postoperative cognitive changes related to CEA is largely unknown. The aim of this study was to examine the associations between postoperative cognitive changes after CEA and long-term survival. Methods: We studied 43 patients 1 day before CEA as well as 4 days and 3 months after surgery with an extensive neuropsychological test array, and followed them for up to 14 years. POCD and POCI relative to baseline were determined with the reliable change index derived from 17 healthy controls. Associations between POCD/POCI and mortality within the patient group were studied with Cox regression analyses adjusted for confounders. Results: POCD in any functional domain was evident in 28% of patients 4 days after surgery and in 33% of patients 3 months after surgery. POCI was shown in 23% of patients at 4 days and in 44% of patients at 3 months. POCD at 3 months was associated with higher long-term mortality (hazard ratio 5.0, 95% CI 1.8-13.9, p = 0.002) compared with patients with no cognitive decline. Conclusions: Our findings suggest that POCD in a stable phase, 3 months after CEA predicts premature death. Evaluation of postoperative cognitive changes is essential, and POCD in a stable phase after CEA should prompt scrutiny of underlying factors and better adherence to therapies to prevent recurrences and to promote early intervention in imminent deterioration.
  • Sipila, Pyry; Rose, Richard J.; Kaprio, Jaakko (2016)
    AimsTo determine if associations of alcohol consumption with all-cause mortality replicate in discordant monozygotic twin comparisons that control for familial and genetic confounds. DesignA 30-year prospective follow-up. SettingPopulation-based older Finnish twin cohort. ParticipantsSame-sex twins, aged 24-60years at the end of 1981, without overt comorbidities, completed questionnaires in 1975 and 1981 with response rates of 89 and 84%. A total of 15607 twins were available for mortality follow-up from the date of returned 1981 questionnaires to 31December 2011; 14787 twins with complete information were analysed. MeasurementsSelf-reported monthly alcohol consumption, heavy drinking occasions (HDO) and alcohol-induced blackouts. Adjustments for age, gender, marital and smoking status, physical activity, obesity, education and social class. FindingsAmong twins as individuals, high levels of monthly alcohol consumption (259g/month) associated with earlier mortality [hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.47-1.81]. That association was replicated in comparisons of all informatively drinking-discordant twin pairs (HR=1.91, 95% CI=1.49-2.45) and within discordant monozygotic (MZ) twin pairs (HR=2.24, 95% CI=1.31-3.85), with comparable effect size. Smaller samples of MZ twins discordant for HDO and blackouts limited power; a significant association with mortality was found for multiple blackouts (HR=2.82, 95% CI=1.30-6.08), but not for HDO. ConclusionsThe associations of high levels of monthly alcohol consumption and alcohol-induced blackouts with increased all-cause mortality among Finnish twins cannot be explained by familial or genetic confounds; the explanation appears to be causal.
  • Nyman, Anna; Munck, Petriina; Koivisto, Mari; Hagelstam, Camilla; Korhonen, Tapio; Lehtonen, Liisa; Haataja, Leena (2019)
    Objective: Executive function (EF) problems of children born at very low birth weight (VLBW; = 70 had clinically significant problems in the Working Memory subscale at school. Although they had clinically significant problems at home in the Behavioral Regulation Index, the difference disappeared when adjusted for paternal education. Lower gestational age, lower birth weight z-score, surgical necrotizing enterocolitis, low paternal and maternal education, and lower full-scale IQ were identified to be risk factors for higher scores in ecological assessment of EF. Conclusion: VLBW or VLGA children in this cohort exhibit fewer EF problems in ecological assessment of EF compared to previous literature. EF problems of this study population vary by home and school setting and are emphasized in working memory at school. Screening for EF problems in school environment is recommended to target the support.
  • Tikka, Sini (Helsingin yliopisto, 2019)
    Masennustilat ovat yleisimpiä mielenterveyden häiriöitä ja kansanterveyden suurimpia ongelmia. Vakava ja normaalia nuoruuden kehitystä estävä masennusoireilu on huomattava ajoissa. Varhaisessa vaiheessa tarjottu tuki ja hoito parantavat masennuksen ennustetta ja ehkäisevät mielenterveyssyistä johtuvaa syrjäytymistä. Masennus on myös merkittävä itsetuhoisen käytöksen riskitekijä. Temperamentin ja luonteenpiirteiden on todettu olevan yhteydessä masennukseen. Tätä yhteyttä on nuorilla kuitenkin tutkittu kohtalaisen vähän verrattuna aikuisiin. Tässä tutkimuksessa pyrittiin selvittämään persoonallisuuden yhteyttä masennuksen kulkuun ja itsetuhoisuuteen nuorilla. Tutkimus toteutettiin osana Terveyden ja hyvinvoinnin laitoksen ADS-tutkimushanketta (Adolescent Depression Study). Tutkimusaineisto on kerätty Peijaksen sairaalan nuorisopsykiatrian avohoitoon tulleista masennusta sairastavista potilaista (N=218). Potilaiden masennusoireita ja itsetuhoisuutta arvioitiin psykiatrisin diagnostisin haastatteluin. Masennuksen kulkua ja itsetuhoisen käytöksen esiintymistä seurattiin vielä yhden ja kahdeksan vuoden jälkeen alkuarviosta. Persoonallisuutta lähestyttiin Cloningerin temperamentti- ja luonteenpiirremallin näkökulmasta. Potilaat täyttivät persoonallisuutta arvioivan TCI-kyselyn (Temperament and Character Inventory) kahdeksanvuotisseurantahaastattelun yhteydessä. Analyyseissä nousi esiin temperamenttipiirteistä korkean vaikeuksien välttämisen (Harm Avoidance) ja luonteenpiirteistä matalan itseohjautuvuuden (Self Directedness) yhteys ajankohtaiseen ja krooniseen masennukseen. Lisäksi kroonisesti masentuneilla nuorilla havaittiin keskimäärin matalampaa yhteistyöhalukkuutta (Co-operativeness). Korkea vaikeuksien välttäminen osoittautui myös itsemurhayrityksen vaaratekijäksi. Itsemurhaa yrittäneillä havaittiin lisäksi luonteenpiirteiden osalta korkea itsen ja maailmankaikkeuden yhtenäisyyden kokemus (Self-transcendence), sekä matala yhteistyöhalukkuus ja itseohjautuvuus. Itsensä vahingoittamiseen ilman itsemurhatarkoitusta liittyi itsen ja maailmankaikkeuden yhtenäisyyden kokemus ja temperamenttipiirteistä sinnikkyys (Persistence). Persoonallisuuspiirteillä todettiin siis yhteys masennuksen kulkuun ja itsetuhoisuuteen myös nuorilla. Tätä yhteyttä voitaisiin tutkia lisää nuoruusiän masennuksen kroonistumisen ja itsetuhoisuuden riskinarvioinnin, sekä hoidon suunnittelun kehittämiseksi.
  • Svedenkrans, Jenny; Ekblom, Örjan; Domellöf, Magnus; Fellman, Vineta; Norman, Mikael; Bohlin, Kajsa (2020)
    Physical activity (PA) can prevent cardiovascular diseases. Because of increased risks of impairments affecting motor activity, PA in children born preterm may differ from that in children born at term. In this prospective cohort study, we compared objectively measured PA in 71 children born extremely preterm (
  • van Dongen, Myrna M. E.; Aarnio, Karoliina; Martinez-Majander, Nicolas; Pirinen, Jani; Sinisalo, Juha; Lehto, Mika; Kaste, Markku; Tatlisumak, Turgut; de Leeuw, Frank-Erik; Putaala, Jukka (2019)
    Background: Knowledge on the use of secondary preventive medication in young adults is limited. Methods: We included 936 first-ever ischemic stroke 30-day survivors aged 15-49, enrolled in the Helsinki Young Stroke Registry, 1994-2007. Follow-up data until 2012 came from Finnish Care Register, Statistics Finland, and Social Insurance Institution of Finland. Usage thresholds were defined as non-users, low (prescription coverage 80%). Adjusted Cox regression allowed assessing the association of usage with all-cause mortality and recurrent vascular events. Results: Of our patients, 40.5% were non-users, 7.8% had low usage, 11.8% intermediate usage and 40.0% high usage. Median follow-up was 8.3 years. Compared to non-users, risk of mortality and recurrent stroke or TIA was lower for patients with low-intermediate (HR 0.40, 95% CI 0.22-0.65; HR 0.31, 95% CI 0.18-0.53) and high usage (HR 0.25, 95% CI 0.15-0.42; HR 0.30, 95% CI 0.19-0.46), after adjustment for confounders. Conclusions: Use of antihypertensives was suboptimal in one-third of patients in whom antihypertensives were initially prescribed. Users were at lower risk of mortality and recurrent stroke or TIA compared to non-users.Key Messages The use of antihypertensive medication is suboptimal in one-third of patients in whom antihypertensive medication was initially prescribed after ischemic stroke at young age. The risk of mortality and recurrent stroke or TIA is lower for users of antihypertensive medication after ischemic stroke at young age compared to non-users, after adjustment for relevant confounders including pre-existing hypertension and prior use of antihypertensive medication. Specific guidelines on antihypertensive medication use after ischemic stroke at young age are lacking. However, our results may motivate doctors and patients in gaining better usage of antihypertensive medication, since better usage was associated with more favorable outcome in this study.